. Manual of operative surgery. T-M-CORACOBRACmuS ^ r. 8/C/P/r/S Fig. 1354.—Old dislocation of shoulder. {DoUingcr.) required and so Kochers method of manipulative reduction becomes to DoUinger, the retracted and perhaps sclerosed subscapularisforms the obstacle to reduction in uncomplicated cases and under it lies the headof the humerus in subcoracoid dislocation. If, as happened in one of Bollingers. MPECLMINOR -CmTHUUERI / HPECTMAJOft IIG. 1355.—Old dislocation of slioulder. {Dollinger.) cases, reduction is impossible after section of the su
. Manual of operative surgery. T-M-CORACOBRACmuS ^ r. 8/C/P/r/S Fig. 1354.—Old dislocation of shoulder. {DoUingcr.) required and so Kochers method of manipulative reduction becomes to DoUinger, the retracted and perhaps sclerosed subscapularisforms the obstacle to reduction in uncomplicated cases and under it lies the headof the humerus in subcoracoid dislocation. If, as happened in one of Bollingers. MPECLMINOR -CmTHUUERI / HPECTMAJOft IIG. 1355.—Old dislocation of slioulder. {Dollinger.) cases, reduction is impossible after section of the subscapular tendon, pull thearm strongly downwards, continue the split in the tendon to the glenoid fossaand remove any obstruction present. Sometimes reduction by arthrotomyproves impossible. Under these circumstances decapitation of the humerus DISLOCATION SHOULDER 1097 and removal of the head is proper, unless a new joint has formed giving satis-factory function. Usually there is great pain and disturbance due to pressureon the vessels and nerves. The operation is essentially the same as that forreduction of the dislocation, but the head of the bone is removed after section ofits neck by means of a Gigli wire saw. Enough bone must be removed to insurea good new joint. As an aid to the making of a new joint one may cover thedivided end of the humerus with the flap of muscle or, better, of fascia and excision, Jona
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